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Pharmacists and drug-interactions

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  • Pharmacists and drug-interactions

    Had a prescription yesterday for an 85year old man

    Naproxen 500mg bd 20 tabs
    Movelat gel apply tds
    Paracetamol 0.5-1g qds 100

    Dispenser/Tech happily produced labels and dispensed ready for checking,,,at this particular pharmacy..dispenser/tech does label but sometimes runs off potential drug -drug interations.....but yesterday she didn't....cause he was elderly and on an NSAID I just wanted to know whether he was on BP meds or Aspirin, but shock horror he was on Warfarin 1mg,3mg...quite a few elders have gone to the other side after taking NSAIDs and Warfarin....

    called GP who expalined the guy also had CDK stage 3and coupled with warfarin too...was reluctant to prescribe but the benefits outweigh the risk and patient aware of potential harm

    my question to fellow colleagues

    1. although I documented intervention on patients' PMR notes..could I have refused to dispense as I did not feel comfortable at all
    2. if the prescription had been checked of by an ACT...and I was happy with script ( but had not checked PMR) and the patient suffered ill effects (highly likely he will) ... will I as a pharmacist be liable?
    Kemzo the pharmacist forumly known as kemzero

  • #2
    Re: Pharmacists and drug-interactions

    Warfarin and NSAIDS very common. On asking pts, have usually been having for years.
    johnep

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    • #3
      Re: Pharmacists and drug-interactions

      Am trying to get throught the Warfarin CPPE course but failing dismally but it points out that patients can be on interacting drugs as long as they are monitored closely when they first get them.

      After all just because someone's on warfarin it doesn't mean that they're not going to need NSAIDs for something.

      As for your questions, it is my understanding that you can refuse to dispense anything. Of course this contravenes the terms of service so you're going to need bloody good justification for doing it in case it gets taken further. But we are professionals and sometimes professional ethics mean you hace to say "I'm sorry, I'm not dispensing that."

      Re ACTs I believe that if the ACT follows SOPs correctly then the pharmacist is responsible for any errors. But anywhere that uses ACTs SHOULD be set up so that any and all interactions are brought to the pharmacist's attention so that clinical checks can be carried out correctly.
      Linnear MRPharmS

      Foetal Alcohol Spectrum Disorder: The biggest cause of brain damage and 100% preventable.

      In pregnancy: 1 fag is not safe, 1 x-ray is not safe and 1 drink is not safe.



      For handy pharmacy links try
      pharmacistance.co.uk

      If you like my posts or letters in the journal try my books!
      eloquent-e-tales

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      • #4
        Re: Pharmacists and drug-interactions

        Originally posted by johnep View Post
        Warfarin and NSAIDS very common. On asking pts, have usually been having for years.
        johnep

        Funny....quite a few have also died as a result of severe heamorraging
        Kemzo the pharmacist forumly known as kemzero

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        • #5
          Re: Pharmacists and drug-interactions

          http://www.liv.ac.uk/~druginfo/csm/ADR_Bulletin25.pdf

          Jeff

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          • #6
            Re: Pharmacists and drug-interactions

            Originally posted by kemzero View Post




            my question to fellow colleagues

            1. although I documented intervention on patients' PMR notes..could I have refused to dispense as I did not feel comfortable at all
            2. if the prescription had been checked of by an ACT...and I was happy with script ( but had not checked PMR) and the patient suffered ill effects (highly likely he will) ... will I as a pharmacist be liable?
            If you pass it as OK and there is a problem - yes you are liable
            If you refuse to dispense and there is a problem - yes you are liable

            Can win I'm afraid - just make sure your actions are "reasonable" document and rely on the PDA to sort it out.

            I hate this job sometimes.

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